Excessive scarring after facelift? (Photos)

I am a little concerned about the scarring on the right hand side at the back of my neck, as it is very long and below the hairline. Also the scarring above both temples near the hairline seems very far forward. The scars seem very prominent and are not as hidden in the hairline as I had hoped. Other people pictures that I have seen on here seem to have the scars more hidden under the hairline than mine. Is my scarring normal? How long before they fade enough, for me to go back to my very short hairstyle?

Doctor Answers 22

Scar Management

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.

Scar Management tips:
  1. Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
  2. Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
  3. Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
  4. Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
  5. Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Topical and laser and IPL treatments may help

There are things to do during the early phase of healing that may help.  Lasers and IPL treatments for red and hypertrophic scars diminish the vascularity and inflammation and may help the scarring resolve. Utilizing lasers and IPL has occurred for many years, but is often ignored by many surgeons, who are unaware of the benefits.

Topical silicone gels, injectable steroids and 5fu, silicone sheets, and the like can also help.

Gregory S. Keller, MD, FACS
Santa Barbara Facial Plastic Surgeon
4.9 out of 5 stars 12 reviews

Facelift

Thank you for sending images. While your scars appear fairly visible, it also appears to be early in the healing process. Scars will mature with time and soften on their own. In addition, your surgeon can help speed things along with scar fading creams, steroid injections, and even laser. 

I would recommend close follow up with your surgeon. Let them know your concerns. If after a full year your scars are still not satisfactory, consider a scar revision and maybe a second opinion.

Mark Hamilton, MD
Indianapolis Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Scars

You are very early in the healing process, possibly 2-3 weeks.  The scars will definitely improve.  Now it is possible to consider a revision to make them thinner but probably best to wait a few months.  

Scarring after Facelift

As a general rule in plastic surgery procedures, incisions are quite biologically active during the first several months, and do not begin to settle down and improve much before six months.  The total time for scars to settle is at least 12 months, and could extend to 18 months.  Although your images show prominent scars with some hypertrophic characteristics, it is not clear how long after surgery these images were taken.  In addition to time, other factors (like genetics or skin tightness at the time of suture placement) influence scar outcomes.

Because genetics are so important to scar results, there is no absolute "normal" in post-op scarring.  In my experience, your incisions show more prominence than most patients, although I have seen more scar thickening on rare occasions.  If you are in the early phase of healing after surgery, I would advise conservative approaches such as topical scar therapy or injection of steroids until scar stability is seen.  If your surgery was a year ago or longer, you may be a candidate for other approaches, including surgical revision, to help reduce visibility.   A board-certified plastic surgeon is the ideal specialist to guide you through these choices.

Saul R. Berger, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 4 reviews

Visible scars after facelift

Thank you for your question and photos. You don't say but it looks like your are relatively recent since your surgery. You have developed what is called keloid scars, which is overactive scar healing. This can be treated with topical scar-gels as well as serial cortisone injections, Discuss this with your surgeon and be patient. In the great majority of cases this will respond to treatment and eventually the scars will fade away. 

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Face lift and scars

Scars are unavoidable in face lift but you are right in that they can be camouflaged. The scar will develop, as any scar does, over 1 year. It does depend how long you are out after surgery?  There are many things that can be done at this stage to maximize scar results and I recommend seeing the plastic surgeon who performed your lift first. That surgeon will be most likely acceptable to discussing options for treatment vs observation depending on what exactly was done during the operation. 

They do appear to be within your hair so they will improve with time and patience but seeing the surgeon again will only help to reassure you and to discuss other options.

"Scar options: Laser treatments, hair transplant, silicone bandages, lotions and potions as well as re-excision and surgical correction. 

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Scarring after FL

You should visit your plastic surgeon. There are things that can be done to help improve those scars.

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 100 reviews

Facelift Incisions

Dear kaymorton, I would speak with your surgeon and discuss the incision placement. In my personal opinion they are poorly placed incisions both in front and behind the ear. The good news is that they will fade in time. Speak with your surgeon regarding your concerns as he or she knows best what your proposed incision areas were to be and what your expectations of those were. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 199 reviews

Scars after a facelift

Thank you for your question and photos. I do see the redness of lines and some surrounding skin redness. This could be part of the healing process and usually subside with time (weeks). In terms of the location of the incisions, your surgeon is the best person to tell you why they planned them in this way. Good luck with your recovery.

Jeffrey Jumaily, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.